How can an acute care hospital ban trans fat and sugary sodas from its menu but still have a McDonald's located on its campus?

Some hospitals are reevaluating their relationship to fast food restaurants after the American Hospital Association issued a call to action last year
urging hospitals to get rid of unhealthy food in their facilities. Recently, the advocacy group Corporate Accountability International asked about two
dozen hospitals nationwide to cut their ties with fast food tenants, leading to a barrage of headlines in the news such as "Do you want fries with your
bypass surgery?"

But as a one hospital in Ohio discovered, eliminating fast food with healthy options is not as easy as it seems, according to the Kaiser Health News report that first
shared the story.

"The Cleveland Clinic tried in vain to terminate its relationship early with McDonald's 10 years ago" but was unable to get out of the contract. It was
able to get rid of its Pizza Hut, however. The hospital, which also doesn't hire smokers, bans trans fat from its own food, and prohibits the sale of
sodas out of vending machines, was concerned about the mixed messages that housing a McDonald's would bring.

Of course McDonald's defends its food menu. Danya Proud, a McDonald's spokesperson, said the chain "offers more variety than ever in our menu, and we
trust that our customers will make appropriate choices for them, their families and their lifestyles."

But in its letter to hospitals, Corporate Accountability International spokesperson Sara Deon wrote that "one in three children will develop type 2 diabetes
as a result of diets high in McDonald's-style junk food."

While only 26 hospitals in the U.S. have a McDonald's, many others contain food vendors like Chic-fil-A, which also market to kids. In a
USA Today article, Deon says that is one of the main problems:

"We hear from physicians saying kids come in for their diabetic check-ups and they hear the parents saying 'If you are well-behaved, we'll take you for
a treat at the McDonald's down the hall," Deon says.

In fairness, some hospital cafeterias don't offer much healthier fare, either. A review by the Physicians Committee for Responsible Medicine (PCRM)
found that some hospitals with fast food vendors also had their own staff cooks serve dishes like fried chicken and country-fried steaks in their
cafeterias.

Pressure from nutrition groups, anti-obesity organizations and cardiologists have also contributed to a gradual reduction in fast food from American
hospitals, but others facing financial burdens have added new fast food vendors. A report by the Physicians Committee for Responsible Medicine surveyed
more than 200 hospitals last year and found the top five "worst hospital environments" had at least one fast food restaurant.

Here's a sample from some of the "worst offenders," according to PCRM:

1. University of South Carolina Hospital Complex in Charleston: Houses five fast food chains, including Chic-fil-A. Its own cafeteria serves hot dogs,
grilled ham and cheese and chicken fried steak.

3. St. Luke's Episcopal Hospital/Texas Heart Institute/Texas Children's Hospital Complex in Texas: Houses four fast-food chains, including a McDonald's
and Chic-fil-A, with a fried-chicken bar in the cafeteria.

4. Naval Medical Center Hospital Facility Complex in San Diego: Patients can choose from three fast food outlets, including McDonald's, or from
cafeteria options such as meatball subs or pork chops.

5. Duke University Hospital Complex in Durham, NC: Houses three fast food outlets, including Chic-fil-A. In the cafeteria, patients can get chicken
wings and sweet and sour pork.

6. Most children's hospitals in California: The 2011 survey found just 7 percent of entrees could be classified as healthy. Only a quarter of the
hospitals used or sold whole wheat bread; 81 percent sold high-sugar products like cookies and ice cream near cafeteria cash registers.